Anatomy
“The uncircumcised penis consists of the penile shaft, glans, urethral meatus, inner and outer surface of the foreskin and the frenulum, the thin band connecting the inner foreskin to the ventral aspect of the glans. A keratinised, stratified squamous epithelium covers the penile shaft and outer surface of the foreskin. This provides a protective barrier against HIV infection. In contrast, the inner mucosal surface of the foreskin is not keratinised and is rich in Langerhans’ cells, making it particularly susceptible to the virus. There is controversy about whether the epithelium of the glans in uncircumcised men is keratinised; some authors claim that it is not, but we have examined the glans of seven circumcised and six uncircumcised men and found the epithelia to be equally keratinised.”
Quote from:Szabo, R. and Short, RV. How does male circumcision protect against HIV infection? BMJ 2000;320:1592.
http://www.bmj.com/cgi/content/full/320/7249/1592. You can view the full text by signing up for a free two week trial subscription.
Several other studies have also found no difference in keratinization between circumcised and uncircumcised men. So this does not seem to be an issue.
Sexual Sensitivity - Anatomy
One of the favourite criticisms levelled at male circumcision by its opponents is the assertion that the foreskin is rich in touch receptors, loss of which reduces sexual pleasure. Research by Bhat et al. (2008) shows that the foreskin has the lowest density of touch receptors of any part of the body. Bhat GH, Bhat MA, Kour K, Shah BA. Density and structural variations of Meissner’s corpuscles at different sites in human glaborous skin. J Anat Soc India 2008;57:30-33. Full text.
A recent review correlating anatomical results with sensitivity studies has also showed that there is no difference between circumcised and uncircumcised men. Guy Cox, John N Krieger and Brian J Morris, 2015. Histological correlates of penile sexual sensation: Does circumcision make a difference? Sexual Medicine 2, 76-85 The paper is open access - read it here.
Sexual Sensitivity - Experimental Studies
Science Daily® (Jan. 8, 2008) — More than 98 per cent of men who are circumcised can enjoy the same levels of sexual satisfaction and performance as men who are not, according to a study of nearly 4,500 males published in the January issue of the UK-based urology journal BJU International.
The randomised trial, carried out by researchers from Uganda and the USA, was undertaken because previous studies showed that the procedure which is now recommended as an efficient way to reduce HIV transmission - showed conflicting results. “Previous studies have been problematic and shown contradictory results”, points out co-author Professor Ronald H Gray from the Bloomberg School of Health at Johns Hopkins University, Baltimore, USA.
“Studies focusing on men circumcised in adulthood were highly selective, because there were medical indications for surgery, circumcised infants can’t provide before and after comparisons and in most studies sample sizes were small and follow-up was short. This study, carried out as part of an HIV prevention initiative, enabled us to compare two groups of men with the same demographic profiles and levels of sexual satisfaction and performance at the start of the study.”
The research team looked at 4,456 sexually experienced Ugandan men aged from 15 to 49 who did not have the HIV virus. 2,210 were randomised to receive circumcision and 2,246 had their circumcision delayed for 24 months. They followed up both sets of men at six, 12 and 24 months and then compared the information on sexual desire, satisfaction and sexual performance for the circumcised men and the control group.
Their research showed that:
- 98.6 per cent of the circumcised men reported no problems in penetration, compared with 99.4 per cent of the control group.
- 99.4 per cent of the circumcised men reported no pain on intercourse, compared with 98.8 per cent of the control group.
Sexual satisfaction was more or less constant in the circumcision group -- 98.5 per cent on enrolment and 98.4 per cent after two years -- but rose slightly from 98 per cent to 99.9 per cent in the control group. This difference was not felt to be clinically significant.
At the six-month visit there was a small, but statistically significant, difference in problems with penetration and pain among the circumcised group, but this was temporary and was not reported at subsequent follow-up visits.
There was considerable consistency between the men in each group when it came to age, religion, marital status, education and number of sexual partners in the last year. The majority of the men were Catholic, married, had one sexual partner and were educated to primary school level.
“Our study clearly shows that being circumcised did not have an adverse effect on the men who underwent the procedure when we compared them with the men who had not yet received surgery” concludes Professor Gray. “Other studies have already shown that being able to reassure men that the procedure won’t affect sexual satisfaction or performance makes them much more likely to be circumcised.”
“BJU International was very keen to publish this large-scale study as there has been a lot of conflicting evidence about the effects of circumcision” says the journal’s Editor, Professor John Fitzpatrick from University College Dublin, Ireland.
Professional comment and opinion
Researcher & writer about circumcision
Post-circumcision keratinisation is indeed a myth. The only study to have investigated it was Szabo and Short. [Reference at the foot of this page - Ed.] They found that the glans was equally keratinised in circumcised and uncircumcised males. The other studies investigated sensitivity, again finding no differences. These indirectly tested keratinisation, which was the (hypothetical) mechanism for the (equally hypothetical) loss of sensitivity.
Here are some interesting studies:
Masters WH, Johnson VE. Human Sexual Response Boston : Little, Brown & Co., 1966. pp.189-91.There is little doubt that the skin of the glans peels in many cases, and becomes drier. But let’s not perpetuate the myth of keratinisation.
Bleustein CB, et al. Effects of circumcision on male penile sensitivity Paper read at the American Urological Association 98th Annual Meeting at Chicago Illinois, April 26-May 1, 2003.
Bleustein CB, et al. Effect of neonatal circumcision on penile neurologic sensation Urology. 2005 Apr; 65(4):773-7.
Payne K, et al. Sensation and sexual arousal in circumcised and uncircumcised men J Sex Med 2007; 4(3): 667-674.
Jake (UK)
Question & Answer
Q. I told my friend I was getting circumcised and he said I would be less sensitive because he read that my penis would become tough and keratinized. Is that true?
A. The epidermis, which includes the glans of your penis, is divided into several layers where cells are formed through mitosis at the innermost layers. They move up the strata changing shape and composition as they differentiate and become filled with keratin. They eventually reach the top layer called stratum corneum and become sloughed off, or desquamated. This process is called keratinization and takes place within weeks all over the body, including the glans of the uncircumcised male. Why do you think uncircumcised men have smegma (cock cheese)? They secrete an oily substance called sebum that is made of fat (lipids) and the debris of the sloughed off keratinized cells, that all mix to become smegma. If the glans of the uncircumcised man was not keratinized his smegma would be quite different. So don’t worry about keratinization. It is a scare tactic. Your glans will dry out and become very smooth to the touch rather than sticky the way it likely is now. But your sensitivity will be exquisite and you will enjoy sex as much or more than before you were circumcised.
Dr. Bob (New York, USA)
Experiential comments submitted by correspondents
The Canadian viewpoint
I was circumcised two years ago, at the age of 22. I didn’t lose any sensitivity at all on account of my circumcision, the removal of the frenelum or the taping back of my foreskin that I was previously doing. And no studies have ever conclusively proven that any sensitivity is lost as a result of circumcision. It’s important to note, too, that the nerves that served the foreskin (which I have never found erogenous) do not shrivel up and die when you’re circumcised; they remain at the circumcision scar - and that can be highly erogenous.
It is true that the sensation of sex changes quite significantly as a result of circumcision, but I don’t think sensitivity is changed at all, one way or another. I greatly prefer my circumcised state.
Lawrence (Toronto, Canada)
Circumcised at age 35
I was circumcised at 35 and have not noticed any loss of sensitivity. As other guys have pointed out, sex feels different after circumcision, but I haven’t noticed any postings from guys cut as adults who say their dicks are now numb and dull. Lawrence is right when he says that the scar is very sensitive since it has a concentration of nerves, and the same with the inner foreskin, since this is now exposed with all of those nerves under the skin!
Paul (USA)
Circumcised as an adult
As part of the healing process the glans will likely peel, unless you have routinely kept for your foreskin pulled back prior to the circumcision. If not, you can expect a sort of "dry skin" to form over the glans (between 2 and 4 weeks after surgery, typically) which will peel off. This is not the same as keratinisation; it will seem as if your glans had sunburn. This is not a problem and is perfectly normal. It will not make your penis less sensitive as some anti-circumcision activists claim. To the contrary, I found my penis had a new, velvety smooth texture and touch on the glans and inner lining was more pleasurable than before my circumcision.
Justin (Oregon, USA)
Circumcised at 13
I was circumcised at 13. I lived in California where 95% of boys my age were cut. I have never regretted it. The tight skin on the shaft gives much more feeling when rubbed then the lose skin when uncut. Most people who oppose circumcision state that the nerves in the foreskin are eliminated, leading to less feeling. This I found was false. The nerves in the foreskin run down the entire length of the penis. When circumcised, the nerve endings are now exposed where the scar is which makes this an extremely sensitive area. Much more than with the foreskin. The feeling at ejaculation is much stronger than before being cut. Also the smegma and it’s odor are gone. I have no regrets and we had our son circumcised. I’ve never met a woman who wished I had a foreskin.
RM (USA)
Circumcised as an adult
I think that people who have not enjoyed both uncut and cut states find it difficult to understand the matter of sensitivity, compounded no doubt by the fact that every person has a different experience. Having been cut some 25 or more years ago, as an adult, I can affirm that the sensitivity is very different now. Before, I could masturbate quite quickly to climax by simply moving the shaft skin firmly up and down, but the resulting climax was not especially strong. Now it takes much longer if I concentrate on rubbing just the head, normally using a lube to minimize the amount of movement of the little remaining shaft skin. However the sensation is quite mind-blowing; far, far stronger than I ever experienced uncut. So, even though it’s a little more effort, I vastly prefer my current cut state, and would never want to go back.
Penetrative sex and oral are similarly much improved, as is the feeling when my wife gives me manual stimulation. Those cut as babies can be assured that they really aren’t missing much, though I do appreciate that some people do enjoy the versatility of a foreskin, especially many gays. However, on balance, the many advantages of circumcision greatly outweigh the few disadvantages.
Cliff (UK)
Circumcised at age 15
When I was circumcised my knob definitely did not NOT lose any sensitivity. In fact, it became much more sensitive; that was a problem because it rubbed against my boxers and it made me hard (once to the point of orgasm). Embarrassing when doing sport! I was forced to wear tight underwear or swim shorts to hold it in position; boxer-briefs still caused the same problem. If you want to be circumcised, try and leave your foreskin back for a few weeks. If you’ve got a tight skin DON’T let doctors stretch it; very painful and embarrassing!
Ben (UK)
A comment from our resident statistician (back then, now editor!)
My survey asked women who had experienced both sorts which were more sensitive; the result was pretty much an even vote. This seems to me to show that there isn’t much difference. I didn’t lose any sensitivity when I got cut.
I suspect that there are two factors in so-called loss of sensitivity:
- A glans which is normally foreskin-covered most of the time (not necessarily the case in an uncircumcised man) will be damp. It will drag on clothes etc. when exposed, creating uncomfortable sensations. This ceases once it dries out - but the sensation is still there as soon as the glans is moist again. If you are circumcised, try wetting your glans thoroughly with saliva then do up your trousers again - you’ll see what I mean. This shows that you haven’t lost this sort of non-sexual sensitivity.
- If someone has had (because of phimosis) a glans which has never seen the light of day, he will have no experience of regular contact of anything with the glans. The brain has no experience of blocking out these sensations when they are not required. The situation is made worse because of the dampness factor (above). The brain soon learns to adapt to this - the sensitivity hasn’t just changed, the person has just learned to ignore it. In a man with a normal foreskin this will not occur, since he will have been accustomed to an exposed glans (regular teenage erections, sex-play, masturbation etc). So his brain has already learned how to handle an exposed knob.
James Badger (NSW)
A recircumcision experience
I was circumcised at age 27 and recirced at 41. That was 12 years ago, so I would say that the long term results are in. I notice that sensitivity is a major issue in correspondence and rightly should be. After all, who wants to give up that? My experience is that there is very little loss of sensitivity, if any, following the operation. Most of my inner foreskin was removed with the first circ and yet I felt that intercourse was so much better, or at least a lot different. The main thing uncircumcised, was that the skin covered the head on the back stroke, so the inner lining was facing the wrong way anyhow. I suffered from premature ejaculation for about 6 months following the first circ and my urologist had told me that I would be "quick on the trigger". Today I would say that sex would be hard to improve on.
Loren (USA)
Another satisfactory outcome
Before being circumcised at the age of 19 - a move that satisfied both my then partner and myself - I found all sorts of techniques to keep my foreskin retracted (elastic bands, pushing the inner skin inside the outer skin, and so on) but there was really no way of having the sensitivity that being circumcised gives during sex.
Those of us who have been cut as young adults know that the "exquisite sensitivity" of foreskins is pure hogwash. The foreskin is a sleeve of skin whose sole advantage, if any, may be to enable a selfish male to jerk off inside himself while having sex with a partner. This is, to say the least, a doubtful advantage. Being circumcised increases penile sensitivity. The sensitivity of the scar is fabulous, having no frenulum means you can thrust without the fear it will be torn, and with experience comes a greater ability to not only feel your partner better (which is particularly important when you have vaginal sex), but also respond and control yourself better. As to the "choice" question, I’ve never encountered a male circumcised as an adult who didn’t wish he had been done as an infant!
Henri (Canada)
Better staying power
Circumcision certainly does affect sexual satisfaction. Before I was circumcised, I could last fairly well, but when it was time to orgasm, then it was time to orgasm and that was that! However, circumcision gives the ability to control the timing of orgasm very effectively, in that when it is approaching, one can slow down a little and hold off for as long as one (and one’s wife/partner) wants. Of course, if one gets past the point of "ejaculatory inevitability" then there’s no controlling it and it will just happen. There’s no doubt that circumcision gives one excellent staying power by comparison with being uncut, despite the fact that the sensation during intercourse is very much more intense.
Pony (UK)
Acknowledgements
The following resources were used in the preparation of this web page:
Correspondence by members of the INTER-CIRC and CIRCLIST discussion groups.
Szabo, R. and Short, RV. How does male circumcision protect against HIV infection? BMJ 2000;320:1592.
Science Daily. Report dated Jan. 8, 2008.
Kigozi et al. The effect of male circumcision on sexual satisfaction and function, results from a randomized trial of male circumcision for human immunodeficiency virus prevention. Rakai, Uganda. BJU International. Volume 101, pp 65-70. January 2008.
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